Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
Division of Pulmonary and Sleep Medicine, Seattle Children's Hospital, Seattle, Washington, U.S.A.
Laryngoscope. 2023 Jul;133(7):1749-1756. doi: 10.1002/lary.30374. Epub 2022 Sep 7.
To assess the efficacy of interarytenoid injection augmentation (IAIA) and the ability of IAIA to predict response to interarytenoid suture augmentation (IASA) based on diet advancement on video fluoroscopic swallow studies (VFSS).
Retrospective cohort analysis of patients with persistent pharyngeal dysphagia at a tertiary children's hospital with VFSS pre- and post-IAIA were included between March 2011 and June 2019.
Median age of the 229 patients was 2.2 years (5.8 months-19 years). Interarytenoid mucosal height (IAMH) was found to be above the false vocal folds in 112 patients (53.4%) and at true vocal folds in 10 (4.9%) patients. On VFSS post-IAIA, 95 (41.5%) patients were successfully advanced in recommended diet consistency, 115 (50.2%) were stable, and 19 (8.3%) needed thicker consistency. Paired t-tests on pre- and post-operative consistency scores showed significant improvement, p-value of <0.0001, 95% confidence interval (CI; 0.50-0.85). Poisson regression found no covariates with significant association with improvement on IAIA. For IASA patients, 35/60 (58.3%) improved on post-op VFSS. Paired t-tests on pre- and post-operative consistency scores showed significant improvement, p-value of <0.0001, 95% CI (0.63-1.33). Positive predictive value for IAIA predicting response to IASA was 77% with positive likelihood ratio of 2.3. The response to IAIA versus no response to IAIA likelihood ratios were found to have a statistically significant difference (p < 0.05).
Our study suggests IAIA yields objective improvement in swallow function on VFSS in nearly half of our patients and may be a reliable diagnostic tool to predict response to IASA in patients with persistent pharyngeal dysphagia with or without a laryngeal cleft.
3 Laryngoscope, 133:1749-1756, 2023.
评估会厌间注射增强术（IAIA）的疗效，以及基于视频荧光透视吞咽研究（VFSS）中饮食进展情况，IAIA 预测会厌间缝线增强术（IASA）反应的能力。
回顾性分析 2011 年 3 月至 2019 年 6 月在一家三级儿童医院接受 VFSS 检查的持续性咽困难患者，这些患者在接受 IAIA 前后均接受了检查。
229 例患者的中位年龄为 2.2 岁（5.8 个月-19 岁）。112 例（53.4%）患者的会厌间黏膜高度（IAMH）位于假声带上方，10 例（4.9%）患者位于真声带上方。IAIA 后 VFSS 检查，95 例（41.5%）患者可成功推进推荐的饮食稠度，115 例（50.2%）患者病情稳定，19 例（8.3%）患者需要更稠的饮食。术前和术后一致性评分的配对 t 检验显示有显著改善，p 值<0.0001，95%置信区间（CI；0.50-0.85）。泊松回归发现没有协变量与 IAIA 的改善有显著关联。对于 IASA 患者，60 例中有 35 例（58.3%）在术后 VFSS 检查中得到改善。术前和术后一致性评分的配对 t 检验显示有显著改善，p 值<0.0001，95%置信区间（CI；0.63-1.33）。IAIA 预测 IASA 反应的阳性预测值为 77%，阳性似然比为 2.3。IAIA 有反应与无反应的可能性比率有统计学显著差异（p<0.05）。
我们的研究表明，IAIA 在近一半的患者中在 VFSS 上产生了吞咽功能的客观改善，并且可能是一种可靠的诊断工具，可预测伴有或不伴有喉裂的持续性咽困难患者对 IASA 的反应。
3 级喉镜，133：1749-1756，2023。
